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Manager Practice



The Fit for Work scheme, funded by the Department for Work and Pensions, is being rolled out across the UK and should be fully operational in Scotland, England and Wales later in 2015. It provides an occupational health assessment and general health and work advice to employees, employers and GPs with the aim of helping individuals stay in or return to work. Crucially, employees must give their consent to take part in the scheme, so you can’t “make” your receptionist participate. Under the scheme, once the employee reaches four weeks of sickness absence, they can be referred by their GP for an occupational health assessment to examine the issues preventing their return to work. Fit for Work will then create a return-to-work plan including

recommendations to help them get back to work and information on where to find further advice. Free advice is also available to employers, employees and GPs by phone or on the Fit for Work and Fit for Work Scotland websites. It would be advisable to update your practice sickness policy to reflect the new scheme.


One of our dental patients owed the practice £500 following private treatment to root treat and place a crown on one of his teeth. We have sent out several written reminders in recent months but only a third has so far been paid. A few days ago the dentist left a message on the patient’s home answering machine asking him to call the practice about the unpaid bill. The patient has since complained about a breach of confidentiality because his wife heard the message and did not know about the debt.


Patients should only be contacted by phone if they have given their express consent for you to do so. Even then, sensitive patient information should never be disclosed in tel- ephone messages due to the potential for a third party to intercept them. In this case, confidentiality has been breached and the patient should be sent a written apology acknowledging the mistake and offering reassur- ances that it will not be repeated. Practice systems regarding confidentiality should be reviewed and details of how procedures have been improved should also be outlined in writing to the patient.


I have heard the Information Commissioner’s Office will be carrying

out checks on GP practices. Can they come into our practice without asking us first?


Since February 2015, the ICO has been able to enter premises – including GP practices – without consent to carry out compulsory data protection audits. Consent was previously required for audits within the NHS, but this rule no longer stands. The ICO plans to use its powers to target poor performing parts of the health sector and act before a breach occurs. Practices should have a robust system in place to ensure patient data is stored and shared securely. Ensure your practice has appropriate security arrangements in place and consider the potential for data breaches in all electronic

communications involving confidential patient data. Encryption can reduce some risks, identifiable data should never be stored on personal computers, and sufficient IT training and support should be available to staff. The ICO has powers to impose monetary penalties, issue undertakings or even launch criminal proceedings in organisations failing to protect private data.

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It would be worth considering waiving the outstanding debt in recognition of the distress caused.


A long-standing patient who is recovering from cancer has recently come into the practice to give her GP a large bottle of malt whisky and an expensive box of chocolates to thank him for the care he has provided over the past few months. The patient insists it is nothing more than a sign of appreciation for all that the doctor has done, but I am unsure whether it is appropriate to accept such a gift.


The issue of accepting or refusing a patient gift is a difficult one. Sometimes there may be no harm in accepting a small token of gratitude, but other gifts may represent something more. The GMC’s Good Medical Practice advises doctors not to “ask for or accept any inducement, gift or hospitality which may affect or be seen to affect your judgement,” adding that doctors “must not encourage patients to give, lend or bequeath money or gifts that will directly or indirectly benefit you.” A strict “no gifts” policy may be difficult to enforce but you must consider whether accepting a gift could be seen to influence the doctor’s decision-making, and you should be able to demonstrate that it hasn’t. Consider discussing the offer of a gift with the patient and make it clear that their gesture will not have any impact on the care they receive. There is often concern about insulting or upsetting a patient by not accepting a gift but you should respectfully refuse/return anything that you feel is inappropriate. A practice gift register may be a helpful way of noting correspondence or conversations surrounding the offer of a gift, as well as reasons for accepting it.

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